Female Pelvic Medicine & Reconstructive Surgery:
1The Institute for Female Pelvic Medicine & Reconstructive Surgery, Allentown, PA; 2Scott & White, Temple, TX; 3Brigham & Women's Hospital, Boston, MA; 4Evanston Northshore Hospital, Evanston, IL; 5University of Pennsylvania, Philadlephia, PA; 6Loyola University, Chicago, IL; 7University of Texas Southwestern, Dallas, TX; 8Greater Baltimore Medical Center, Baltimore, MD; 9University of New Mexico, Albuquerque, NM
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Stephanie Molden;Ethicon:honorarium:preceptor; Miles Murphy: Ethicon:Consulting Fee:Consultant;AMS:Consulting Fee:Consultant;Bard:Consulting Fee:Consultant
The purpose of this study was to determine outcomes of sling revision after MUS placement and whether timing of when sling revision was performed affected those outcomes.
MATERIALS AND METHODS:
This is a multicenter study including patients who underwent MUS placement and subsequent sling revision secondary to voiding dysfunction from January 1999 to January 2007 from nine urogynecologic centers across the United States. Data collected included patient characteristics, urodynamic data, operative data for sling placement and revision, and clinical information before and after sling revision. Diagnostic outcomes before and after sling revision were compared for all sling revision patients with complete data. For categorical variables separate McNemar tests were used, with a Bonferroni-adjusted p-value of .0125 denoting statistical significance. Logistic regression analyses were performed to determine if revision timing predicted voiding dysfunction and stress incontinence, with a Bonferroni-adjusted p-value of .025 denoting statistical significance (n = 165).
One hundred ninety seven patients met study criteria; 175 had complete data. Median length of follow-up was 2 months. Overall, 70% (133) of MUS were retropubic and 30% (56) were obturator slings. General anesthesia was utilized in 68.6% (118) cases while local or regional anesthesia was used in 31.4% (61). Slings were mostly tensioned visually, 67.5%, with 30.6% set by cough or credé maneuvers. A suburethral spacer was also used in 51.3%. Concurrent surgeries were performed in 132 cases (69.5%) and complications were seen in 15 (8.6%) of cases. Associated symptoms of voiding dysfunction included de novo or worsened OAB symptoms in 41% (78), urinary tract infections 40% (74), and SUI 12.6% (24) after sling. MUS revision was accomplished by cutting the mesh (48.7%) followed by excision of some portion of mesh (32.1%). Few patients underwent multiple revisions (6.2%) or remained catheter dependent (4.1%). After revision, SUI resolved in 38.1%, UTIs were no longer experienced by 69.4%, and OAB resolved in 74.6%. In comparison 21.4% experienced de novo SUI (P < .001), 18.4% de novo UTIs (P < .001), and 12% experienced de novo OAB symptoms after revision (P < .001) Voiding dysfunction resolved in 80%, however 10% experienced new voiding dysfunction symptoms after revision (P < .001). There was a trend toward increased voiding dysfunction (P = .04) and de novo/worsened OAB symptoms (P = .03) in retropubic slings versus obturator slings after revision. The median time from sling placement to revision was 62 days. Sling revision timing was not a statistically significant predictor of either voiding dysfunction (P = .72) or SUI (P = .10).
Sling revision is successful in achieving resolution of voiding dysfunction symptoms in 80% of patients. Furthermore, revision decreased the overall occurrence of UTIs and OAB symptoms while de novo and persistent SUI is relatively low at 26.3%. Resolution of voiding dysfunction and post-revision SUI is independent of method and timing of revision.